Dr K. K. Aggarwal
Padma Shri and Dr B C Roy National Awardee
President, Heart Care Foundation of India
Doctors are regarded as God because their primary job is to save the life of a patient. In fact, they are the messengers of God to look after the health of the sick person. But, Doctors are God later and human beings first.
To err is human and every doctor is likely to make mistakes. The very fact that a doctor is getting himself insured under Indemnity insurance means that medical errors are recognized as a part and parcel of Government policies.
For any error, the Court has decided a financial compensation to the patient and that compensation is paid by the insurance company as the doctor is covered under the Indemnity insurance. Medical negligence on the other hand, if proved, is not covered under the insurance. Therefore, medical negligence has to be differentiated from medical errors.
The error of judgment and difference of opinion are accepted in the law as not negligence and there are ample Supreme Court judgments to support that. Medical accidents are also exempted from being termed negligence by various Supreme Court clarifications/judgments. For a doctor to be punished under medical negligence, there has to be a proof that he willfully did some omission or commission which led to the death or caused harm to a person.
A doctor is also not required to possess the maximum degree of skill and knowledge but is required to possess only an average degree of skill and knowledge. Therefore, when an expert is called for an opinion, he should never give an opinion from his level of perception and knowledge but should take into consideration the knowledge of an average doctor of that specialty.
Recently, one of my friends forwarded a report to me, which showed that in US when the doctors went on a strike, the number of deaths in the city during the strike period reduced. I totally agree with this observation and I am of the firm opinion that if allopathic medical profession ceases to exit, the number of deaths per day will be reduced. But at what cost? It will invariably be at the cost of increased morbidity, impaired quality of life and more sufferings. In that scenario people with sexual dysfunction will live without enjoying sexual life; people with heart failure will live on the bed all the time, patients with TB will be back in sanitariums, patients with fractures will remain on the bed for months together and patients requiring orthopedic surgeries will remain with life-long deformations. To have a better quality of life, one has to pay the price as any intervention or surgery done to improve the quality of life invariably will carry some risk and mortality. Even a simple bypass surgery of the heart carries a mortality of up to 0.5-1%. But for the family whose patient dies that 1%, the mortality is 100%.
In a follow up program on Aaj Tak, the controversial film actor, Aamir Khan, said that every household in India has a negative story to tell about medical doctors. Aamir probably misunderstood or could not differentiate medical errors, medical accidents from medical negligence. People equate money with medical success. Most of the medical disputes occur in private sector when the patient’s relations have to pay money for an unsuccessful surgery or treatment. Attempts have been made to compare the results of medical treatment in India from that of abroad. They are totally incomparable as the amount of fee charged by doctors in India is practically a fraction of a price that is charged in the west. The patients load in India per doctor is also responsible for potential medical errors. One should also remember that the Drug Controller Government of India does not inform doctors about banned drugs, introduction of new drugs or introduction of new equipment. Most doctors depend on technology to be learnt through the manufacturers of respective machines. The manufacturers either bring the training persons from abroad or support the training of Indian doctors abroad. Their interest is ultimately covered as the doctors once trained ultimately end up in purchasing their technology.
When a new drug is launched, as there is no information from Drug Controller of India to individual doctors, they are forced to attend symposia by drug companies, which now come under the purview of unethical doctor-pharma relationship.
Most doctors will write pharmaceutical drugs of a company, which people think is in lieu of a commission they are getting. The reality is that a doctor will invariably write a drug of a company who is constantly spending efforts in educating doctors about new technologies and innovations as both Medical Council of India and the Government of India Health Ministry have no such provisions for the doctors. On the other hand, not attending medical educational programs is considered a professional misconduct by MCI and many state councils.